Tough problem, simple message: PTSD, stroke and long-term care

By now you may have heard: One in four stroke survivors develops post-traumatic stress disorder. This finding was published in PLoS One last week, sparking coverage from many major media outlets. The study's lead author—Donald Edmondson, Ph.D.—recently spoke with me about implications for long-term care providers.

The heavy media coverage of the findings should help with Edmondson's first concern: raising awareness. He said that caregivers have long been aware of the relationship between stroke and depression, but PTSD awareness has come more slowly.

“Only now are we starting to see that this is a serious problem,” Edmondson said. And it's not just a problem related to stroke. Last year, Edmondson and his colleagues at Columbia University Medical Center in New York City found that one in eight heart attack survivors develops PTSD — a condition more commonly associated with combat veterans and sexual assault survivors.

Within the LTC setting, there are some caregivers who are especially well-equipped to help stroke survivors with post-traumatic stress. Edmondson singled out licensed clinical social workers who have training in cognitive behavioral therapy, as well as psychologists and psychiatrists, as important members of the care team for these patients.

Regardless of who takes the lead, someone on the care team should be screening for PTSD in stroke survivors.

“It's as simple as asking questions,” Edmondson said.

Caregivers should ask about recurrent distressing thoughts or nightmares, as well as nervousness, jitteriness, inability to sleep and other signs of physiological hyperarousal, he advised.

Once PTSD is diagnosed, there are “excellent treatments,” Edmondson noted. These include therapy and medications such as fluoxetine (Prozac) and sertraline (Zoloft).

However, PTSD patients often struggle with medication adherence. This could be because they want to avoid any reminder of the source of their trauma, and popping a pill — or monitoring other health indicators — calls to mind their stroke.

“This is a fascinating new question that we don't know enough about yet,” Edmondson said. If PTSD patients are struggling with medication adherence and other treatments for this reason, he hypothesized, they may not be good candidates to use mobile applications to monitor their cardiovascular system.

Mobile apps may be ineffective or even counterproductive for PTSD patients, but caregivers can certainly leverage new technology. The University of Pennsylvania School of Nursing will use $75,000 in grant money to develop PTSD-related e-tools, the American Nurses Foundation announced last Thursday. These tools will include a smartphone app to help nurses assess and treat the condition.

While a positive step, the toolkit will focus on treating veterans who have PTSD. Nurses and other caregivers have a need for PTSD resources that are relevant to all different types of patients, Edmondson's research suggests.

The prevalence of PTSD adds yet another wrinkle to the frequently complex post-acute care needs of stroke survivors. Yet, the main “take home” of his study is simple, according to Edmondson.